| Part ?: To analyze the relevant risk factors for purely PCD in patients with acute necrotizing pancreatitis.Objective: We try to analyze the therapeutic effect of the ANP patients need to be treated by purely PCD in different age,sex,puncture culture influence of microbial,antimicrobial susceptibility,four scoring systems(MCTSI,NJSS,APACHEII,BISAP),SIRS,laboratory examination and other risk factors.We try to find the related risk factors for the treatment of pure PCD and improve the prognosis and therapeutic effect of the patients.Methods: We summarized 50 match entry condition cases of ANP patients with peripancreatic effusion or peripancreatic abscess in the second Affiliated Hospital of Nanchang University from January 2009 to December 2015.According to the prognosis of patients after purely PCD,they were divided into the improved group(26cases)and the deterioration group(24 cases).Collection and comparison the effect of those two groups with age,sex,puncture culture influence of microbial,antimicrobial susceptibility,four scoring systems(MCTSI,NJSS,APACHEII,BISAP),SIRS,laboratory examination and other risk factors.Results:(1)We find that age,sex ratio,puncture time,hospitalization time between the two groups,there is no absolute difference between the general situation(p>0.05);(2)In addition to APACHEII on admission,there are statistical differences between the two groups in the four scoring systems(p<0.05);(3)The existence of patients with multiple infections and those with pan resistant bacteria between two groups' differences are statistically significant(p<0.05);(4)The existence of the patients with different muti drug resistant microbial infection,blood amylase,blood calcium,blood glucose,blood lipid and CRP don't have statistical significance(p>0.05);(5)APACHEII on admission and SIRS between the two group don't have statistical significance(p>0.05).Conclusion:(1)According to the result of MCTSI,NJSS,BISAP before puncture,we can determine whether patients can get benefit from purely PCD or not;(2)By using the result of APACHEII on admission and SIRS,we unable to determine whether SAP patients can get benefit from purely PCD;(3)The emergence of multiple punctures cultures microbial microbial infection or combining antibiotic resistant bacteria that are not recommended to purely PCD.Part ?: To analyze four scoring systems that when to predict and evaluate the effect of purely PCD for acute necrotizing pancreatitis has the highest value.Objective: We try to analyze and compare the predictive value of those 4 kinds of scoring systems at different times.Methods: We summarized 50 match entry condition cases of ANP patients with peripancreatic effusion or peripancreatic abscess in the second Affiliated Hospital of Nanchang University from January 2009 to December 2015.According to the prognosis of patients after purely PCD,they were divided into the improved group(26cases)and the deterioration group(24 cases).Collection and comparison the value of the those scoring system.We tried to find out the whether they have any differences in them at different time and then identified when to have the highest value.Results:(1)We find that APACHEII on admission: AUC=0.615;APACHEII before puncture: AUC=0.798(p<0.05.95%CI: 0.672-0.924),optimal threshold:9,You-den index:0.494,OR:15.33.Z test(p<0.05),it means that there are significant differences at different time.(2)We find that BISAP on admission: AUC=0.7(p=0.008,95%CI: 0.552-0.849),optimal threshold:2,You-den index:0.4,OR:7.94;BISAP before puncture: AUC=0.753(p<0.05.95%CI:0.618-0.888),optimal threshold:2,You-den index: 0.436,OR:9.62.Z test(p<0.05),it means that there are no significant differences in BISAP scores at different time.(3)We find that NJSS on admission: AUC=0.724(p=0.005,95%CI:0.579-0.868),optimal threshold:2,You-den index:0.41,OR:7.07;NJSS before puncture: AUC=0.823(p<0.05.95%CI:0.708-0.938),optimal threshold:3,You-den index:0.475,OR:11.53.Z test(p<0.05),it means that there are significant differences in NJSS scores at differenttime.(4)We find that MCTSI on admission:AUC=0.731(p=0.002,95%CI:0.593-0.869),optimal threshold 5,You-den index:0.346,OR:8.37;MCTSI before puncture: AUC=0.923(p<0.05,95%CI:0.847-0.999),optimal threshold:7,You-den index:0.712,OR:21.9.Z test(p<0.05),it means that there are significant differences in MCTSI scores at different time.Conclusion:(1)According to the result of APACHEII,MCTSI and NJSS,we can predict the clinical benefit of only PCD more accurately than that on admission.(2)We can predict the clinical benefit early that whether patients can only take PCD treatment if we do BISAP examination.(3)If BISAP score>2,NJSS>3,APACHEII score>9,and MCTSI score>7 before puncture,we suggest that we need to choose only PCD more carefully.Part ?: Comparative analysis of four scoring systems in evaluating the effect of purely PCD in the treatment of acute necrotizing pancreatitis.Objective: Try to Analyses and compare the evaluation value of the MCTSI,NJSS,APACHEII,BISAP scoring systems.Methods: We summarized 50 match entry condition cases of ANP patients with peripancreatic effusion or peripancreatic abscess in the second Affiliated Hospital of Nanchang University from January 2009 to December 2015.According to the prognosis of patients after purely PCD,they were divided into the improved group(26cases)and the deterioration group(24 cases).Collection and comparison the value of the those scoring system.We tried to find out the whether they have any differences in those four kinds of scoring systems and then determine which one has the highest value.Results:(1)We find that APACHEII before puncture AUC=0.798(P<0.05,95%CI:0.672-0.924),optimal threshold:9,You-den index:0.494,OR:15.33.There are 22 people from deterioration group and 10 people from improved group whose APACHEII before puncture>9.+LR=2.17,-LR=0.144.(2)We find that BISAP before puncture AUC=0.753(P<0.05,95%CI:0.618-0.888),optimal threshold:2,You-den index= 0.436,OR:9.62.There are 16 people from deterioration group and 6 people from improved group whose BISAP before puncture>2.+LR=2.89,-LR=0.433;(3)We find that NJSS before puncture AUC=0.823(P<0.05,95%CI:0.708-0.938),optimal threshold:3,You-den index:0.475,OR:11.53.There are 16 people from deterioration group and 5 people from improved group whose NJSS before puncture>3.+LR=3.47,-LR=0.412;(4)We find that MCTSI before puncture AUC=0.923(P<0.05,95%CI:0.847-0.999),optimal threshold:7,You-den index:0.712,OR:21.9.There are 16 people from deterioration group and 1 people from improved group whose MCTSI before puncture>7.+LR=19.7,-LR=0.26;(5)We find that there are no differences among those scoring system including APACHEII,BISAP,NJSS before puncture examined by Z test(P>0.05);MCTSI is examined by Z test(P<0.05),and the result shows that there are statistically significant difference between MCTSI and other scoring systems.Conclusion: APACHEII system's sensitivity was better than the others;MCTSI system's specificity was better than the others. |
PDF Full Text Request